Latarjet Procedure: Difference between revisions
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==Description== | ==Description== | ||
The Latarjet procedure is a possible surgical procedure to treat patients with anterior shoulder instability and accompanied bone loss. It involves transferring the coracoid process and its attached conjoint tendon to the anterior glenoid rim. In 1954, Latarjet first proposed the transfer of the coracoid tip by suggesting that the horizontal limb of the coracoid process be fixed to the anteroinferior margin of the glenoid with a screw<ref>Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon chirurgical. 1954;49(8):994-7.</ref> | |||
Biomechanics of Latarjet<ref>Bradley H, Lacheta L, Goldenberg BT, Rosenberg SI, Provencher MT, Millett PJ. Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability in the Athlete–Key Considerations for Rehabilitation. International Journal of Sports Physical Therapy. 2021;16(1):259.</ref> - | |||
# The conjoint tendon acts as a sling to the inferior subscapularis and anteroinferior capsule when the arm is abducted and externally rotate. | |||
# The addition of bone to the glenoid rim increases the anteroposterior (AP) osseous diameter. | |||
# The inferior capsule is reinforced with a portion of the coracoacromial ligament. | |||
A study evaluated the contribution to stability of the bone block, sling, and capsule repair and concluded that the sling effect provided 76-77% and capsule 23-24% of the stability at the end-range arm position and the sling contributed 51-62% and the bone block 38-49% at the mid-range position.<ref>Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, Walch G, Steinmann SP. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. JBJS. 2013 Aug 7;95(15):1390-7.</ref> This is known as the triple blocking effect of the Latarjet procedure, and it should be noted that each portion of the procedure contributes to the overall stability of the GHJ. | |||
==Indication== | ==Indication== | ||
The Latarjet operation employs a triple blocking mechanism, including lengthening the glenoid arc by adding a coracoid graft to the anterior glenoid rim. In the presence of significant glenoid bone loss, various bone-block methods have been used, most commonly the open Latarjet procedure<ref>Degen RM, Camp CL, Werner BC, Dines DM, Dines JS. Trends in bone-block augmentation among recently trained orthopaedic surgeons treating anterior shoulder instability. JBJS. 2016 Jul 6;98(13):e56.</ref> | |||
* Instability with glenoid bone loss | |||
* Combinations of glenoid and humeral bone loss | |||
* Complex soft-tissue injury | |||
* Revision of a Bankart repair | |||
* Patients engaged in high-risk sports (climbing, rugby) or occupations (carpentry), or who have a high risk of recurrence due to the intensity and action of their activity (throwers), are ideal candidates for the Latarjet procedure | |||
==Diagnostic Tests== | ==Diagnostic Tests== | ||
CT scan | |||
==Pre-Op== | |||
MRI | |||
==Pre-Op Physiotherapy== | |||
add text here relating to the pre-operative advice | add text here relating to the pre-operative advice | ||
==Post-Op== | ==Post-Op Physiotherapy== | ||
add text here relating to post-operative rehabilitation | add text here relating to post-operative rehabilitation | ||
==Resources == | ==Resources == | ||
Revision as of 11:39, 5 October 2022
Original Editor - User Name
Top Contributors - Yahya Al-Razi and Shreya Pavaskar
Description[edit | edit source]
The Latarjet procedure is a possible surgical procedure to treat patients with anterior shoulder instability and accompanied bone loss. It involves transferring the coracoid process and its attached conjoint tendon to the anterior glenoid rim. In 1954, Latarjet first proposed the transfer of the coracoid tip by suggesting that the horizontal limb of the coracoid process be fixed to the anteroinferior margin of the glenoid with a screw[1]
Biomechanics of Latarjet[2] -
- The conjoint tendon acts as a sling to the inferior subscapularis and anteroinferior capsule when the arm is abducted and externally rotate.
- The addition of bone to the glenoid rim increases the anteroposterior (AP) osseous diameter.
- The inferior capsule is reinforced with a portion of the coracoacromial ligament.
A study evaluated the contribution to stability of the bone block, sling, and capsule repair and concluded that the sling effect provided 76-77% and capsule 23-24% of the stability at the end-range arm position and the sling contributed 51-62% and the bone block 38-49% at the mid-range position.[3] This is known as the triple blocking effect of the Latarjet procedure, and it should be noted that each portion of the procedure contributes to the overall stability of the GHJ.
Indication[edit | edit source]
The Latarjet operation employs a triple blocking mechanism, including lengthening the glenoid arc by adding a coracoid graft to the anterior glenoid rim. In the presence of significant glenoid bone loss, various bone-block methods have been used, most commonly the open Latarjet procedure[4]
- Instability with glenoid bone loss
- Combinations of glenoid and humeral bone loss
- Complex soft-tissue injury
- Revision of a Bankart repair
- Patients engaged in high-risk sports (climbing, rugby) or occupations (carpentry), or who have a high risk of recurrence due to the intensity and action of their activity (throwers), are ideal candidates for the Latarjet procedure
Diagnostic Tests[edit | edit source]
CT scan
MRI
Pre-Op Physiotherapy[edit | edit source]
add text here relating to the pre-operative advice
Post-Op Physiotherapy[edit | edit source]
add text here relating to post-operative rehabilitation
Resources[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon chirurgical. 1954;49(8):994-7.
- ↑ Bradley H, Lacheta L, Goldenberg BT, Rosenberg SI, Provencher MT, Millett PJ. Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability in the Athlete–Key Considerations for Rehabilitation. International Journal of Sports Physical Therapy. 2021;16(1):259.
- ↑ Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, Walch G, Steinmann SP. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. JBJS. 2013 Aug 7;95(15):1390-7.
- ↑ Degen RM, Camp CL, Werner BC, Dines DM, Dines JS. Trends in bone-block augmentation among recently trained orthopaedic surgeons treating anterior shoulder instability. JBJS. 2016 Jul 6;98(13):e56.
